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Acquaro M, Scelsi L, Pasotti B, Seganti A, Spolverini M, Greco A, Schirinzi S, Turco A, Sanzo A, Savastano S, Rordorf R, Ghio S. Sacubitril/valsartan effects on arrhythmias and left ventricular remodelling in heart failure: An observational study. Vascul Pharmacol 2023; 152:107196. [PMID: 37467909 DOI: 10.1016/j.vph.2023.107196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/04/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023]
Abstract
AIMS Conflicting results have been reported in the literature on the potential antiarrhythmic effect of sacubitril/valsartan in heart failure patients with reduced ejection fraction (HFrEF). The objectives of this study were: 1- to evaluate the long term effects of sacubitril/valsartan on arrhythmic burden in HFrEF patients; 2- to evaluate the correlation between the reduction of premature ventricular complexes during f-up and reverse remodelling. METHODS We identified 255 consecutive HFrEF patients treated with sacubitril/valsartan between March 2017 and May 2020 and followed by the Heart Failure and Cardiac Transplant Unit of IRCCS San Matteo Hospital in Pavia (Italy). Within this subgroup, 153 patients underwent 24 h-Holter-ECG or implantable cardioverter defibrillators (ICD) interrogation at baseline, at 12 months (t1) and at 24 months (t2) and transthoracic echocardiography at baseline and after 12 months after the beginning of sacubitril/valsartan. Cardiac-related hospitalizations were analyzed in the 12 months preceding and during 24 months following the drug starting date. RESULTS Global burden of 24-h premature ventricular complexes (PVC) was significantly reduced at 12 months (t1) and at 24 months (t2) as compared to the same period before treatment (1043 [304-3360] vs 768 [82-2784] at t1 vs 114 [9-333] at t2, P = 0.000). In the subgroup of patients implanted with biventricular ICD (n = 30), the percentage of biventricular pacing increased significantly (96% [94-99] vs 98% [96-99] at t1 vs 98%[97-100] at t2; P = 0.027). The burden of non-sustained ventricular tachycardia and sustained ventricular tachycardia did not change from baseline to t1 and t2, but a reduction of patients with at least one ICD appropriate shock was reported. The correlations between reduction in 24 h PVC and reduction in LV-ESVi or improvement in LVEF were not statistically significant (respectively R = 0.144, P = 0.197 and R = -0.190, P = 0.074). Heart failure related hospitalizations decreased during follow up (11.1% in the year before treatment vs 4.6% at t1 and 4.6% at t2; P = 0.040). CONCLUSION Sacubitril/valsartan reduced the number of premature ventricular complexes and increased the percentage of biventricular pacing in a cohort of HFrEF patients already on optimal medical therapy. PVC reduction did not correlate with reverse left ventricular remodelling. Whether sacubitril/valsartan has any direct antiarrhythmic effects is an issue to be better explored in future studies.
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Affiliation(s)
- Mauro Acquaro
- Department of Molecular Medicine, University of Pavia, Corso Strada Nuova, 65, Pavia, Italy; Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Laura Scelsi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Beatrice Pasotti
- Department of Molecular Medicine, University of Pavia, Corso Strada Nuova, 65, Pavia, Italy; Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandro Seganti
- Department of Molecular Medicine, University of Pavia, Corso Strada Nuova, 65, Pavia, Italy; Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marcello Spolverini
- Department of Molecular Medicine, University of Pavia, Corso Strada Nuova, 65, Pavia, Italy; Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Greco
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sandra Schirinzi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Annalisa Turco
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Sanzo
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Arrhythmia and Electrophysiology Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Arrhythmia and Electrophysiology Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Roberto Rordorf
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Arrhythmia and Electrophysiology Unit, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Carrozzi C, Baldi E, Seganti A, Spolverini M, Pignalosa L, Petracci B, Sanzo A, Savastano S, Rordorf R, Vicentini A. How arrhythmic risk changes over time in patients with low risk Brugada syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Brugada Syndrome (BrS) is an inherited disorder associated with an increased risk of sudden cardiac death (SCD) and is diagnosed by the presence of a Brugada type I ECG pattern, either spontaneous or drug-induced. A spontaneous ECG pattern is one of the two main risk factors for SCD, along with syncope. However, there is still no clear evidence on how and how often to screen patients with drug-induced BrS to detect a spontaneous ECG pattern, therefore allowing to reassess their arrhythmic risk.
Purpose
To determine how many subjects develop a spontaneous ECG pattern among a pool of patients with low risk BrS (drug-induced pattern without history of syncope at the time of diagnosis) observed through systematic ECG Holter monitoring.
Methods
We retrospectively collected data for all patients with low risk BrS treated at our center for at least 12 months between 2016 and 2021. Each patient was tested yearly with at least one 12-lead 24-hour ECG Holter monitoring with high precordial leads (V1-V2, V3-V4, V5-V6 respectively in 2nd, 3rd and 4th intercostal space parasternal left and right). In case of spontaneous pattern detection at two recordings, patients underwent electrophysiological study (EPS) and in case of inducible ventricular arrhythmias, implantable cardiac defibrillator (ICD) placement.
Results
We included 63 patients with low risk BrS. During a median follow-up of 48 months: 1 patient died for SCD (1.6%), 1 experienced syncope (1.6%) and 19 exhibited a spontaneous ECG pattern (30.2%). Of these 19 patients: 18 were males and 5 had a mutation of SCN5A; the average age at the time of spontaneous pattern detection was 48.1±11.5 years. The average number of ECG holters/per patient/per year was 1.1±0.6, the average number of ECG Holters until the detection of a spontaneous pattern was 3.3±1.8, whilst the average number of months in between the diagnosis and the detection of a spontaneous pattern was 43.2±41.1.
After the observation of a spontaneous pattern: 6 patients were excluded from further investigation (as they had already undergone EPS or refused), 1 was directly treated with ICD and 12 underwent EPS, 4 of whom consequently underwent ICD placement. Among these 5 patients who underwent ICD placement – 7.9% of the original 63 patients – we observed 1 appropriate ICD intervention (antitachycardia pacing), 1 inappropriate ICD shock and 1 ICD related complication.
Conclusions
In our population of patients with low risk BrS the detection of a spontaneous ECG pattern is the most common determinant of risk reclassification. Systematic ECG Holter monitoring disclosed the presence of a spontaneous ECG pattern in a relevant number of subjects, allowing to reassess their arrhythmic risk and indication for ICD placement. Our study stresses the importance of periodic evaluation of low risk BrS patients with ECG Holter monitoring and the need for further investigation to define the optimal monitoring strategy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Carrozzi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia and Cardiac Intensive C , Pavia , Italy
| | - E Baldi
- I.R.C.C.S. San Matteo Polyclinic, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology , Pavia , Italy
| | - A Seganti
- Department of Molecular Medicine, Section of Cardiology, University of Pavia and Cardiac Intensive C , Pavia , Italy
| | - M Spolverini
- Department of Molecular Medicine, Section of Cardiology, University of Pavia and Cardiac Intensive C , Pavia , Italy
| | - L Pignalosa
- I.R.C.C.S. San Matteo Polyclinic, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology , Pavia , Italy
| | - B Petracci
- I.R.C.C.S. San Matteo Polyclinic, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology , Pavia , Italy
| | - A Sanzo
- I.R.C.C.S. San Matteo Polyclinic, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology , Pavia , Italy
| | - S Savastano
- I.R.C.C.S. San Matteo Polyclinic, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology , Pavia , Italy
| | - R Rordorf
- I.R.C.C.S. San Matteo Polyclinic, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology , Pavia , Italy
| | - A Vicentini
- I.R.C.C.S. San Matteo Polyclinic, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology , Pavia , Italy
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Corti CG, Seganti A, Sanzo A, Nespoli LF, Goletto S, Izzo F, Zuccotti GV, Mannarino S. Multisystem Inflammatory Syndrome in Children Unmasking Brugada Type 1 Pattern. JACC Case Rep 2022; 4:205-210. [PMID: 35199017 PMCID: PMC8855134 DOI: 10.1016/j.jaccas.2021.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Abstract
We describe the case of a 14-year-old boy hospitalized for multisystem inflammatory syndrome in children who developed atrial fibrillation during the acute phase and a transient Brugada type 1 pattern in the subacute phase. Eight months later, a provocative test with ajmaline confirmed the suspicion of Brugada syndrome. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Carla G. Corti
- Pediatric Cardiology, Department of Pediatrics, Children’s Hospital Vittore Buzzi, Milan, Italy
- Address for correspondence: Dr Carla Giuseppina Corti, Pediatric Cardiology, V. Buzzi Children Hospital, Via Castelvetro 32, Milan 20154, Italy.
| | - Alessandro Seganti
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Sanzo
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luisa F. Nespoli
- Pediatric Cardiology, Department of Pediatrics, Children’s Hospital Vittore Buzzi, Milan, Italy
| | - Sara Goletto
- Pediatric Cardiology, Department of Pediatrics, Children’s Hospital Vittore Buzzi, Milan, Italy
| | - Francesca Izzo
- Division of Pediatric Anesthesia and Intensive Care Unit, Department of Pediatrics, Children’s Hospital Vittore Buzzi, Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Biomedical and Clinical Science “L. Sacco,” University of Milan, Milan, Italy
| | - Savina Mannarino
- Pediatric Cardiology, Department of Pediatrics, Children’s Hospital Vittore Buzzi, Milan, Italy
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Seganti A, De Martino A, Ricci-Tersenghi F. Searching for feasible stationary states in reaction networks by solving a Boolean constraint satisfaction problem. Phys Rev E Stat Nonlin Soft Matter Phys 2014; 89:022139. [PMID: 25353454 DOI: 10.1103/physreve.89.022139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Indexed: 06/04/2023]
Abstract
We analyze the solutions, on single network instances, of a recently introduced class of constraint-satisfaction problems (CSPs), describing feasible steady states of chemical reaction networks. First, we show that the CSPs generalize the scheme known as network expansion, which is recovered in a specific limit. Next, a full statistical mechanics characterization (including the phase diagram and a discussion of the physical origin of the phase transitions) for network expansion is obtained. Finally, we provide a message-passing algorithm to solve the original CSPs in the most general form.
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Affiliation(s)
- A Seganti
- Dipartimento di Fisica, Sapienza Università di Roma, p.le A. Moro 2, 00185 Rome, Italy
| | - A De Martino
- Dipartimento di Fisica, Sapienza Università di Roma, p.le A. Moro 2, 00185 Rome, Italy and IPCF-CNR, UOS di Roma, Dipartimento di Fisica, Sapienza Università di Roma, Rome, Italy and Center for Life Nano Science@Sapienza, Istituto Italiano di Tecnologia, Viale Regina Elena 291, 00161 Rome, Italy
| | - F Ricci-Tersenghi
- Dipartimento di Fisica, Sapienza Università di Roma, p.le A. Moro 2, 00185 Rome, Italy and IPCF-CNR, UOS di Roma, Dipartimento di Fisica, Sapienza Università di Roma, Rome, Italy and INFN, Sezione di Roma 1, Dipartimento di Fisica, Sapienza Università di Roma, Rome, Italy
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Seganti A, Carnevale G, Mucelli R, Solano L, Target M. From sixty-two interviews on 'the worst and the best episode of your life'. Relationships between internal working models and a grammatical scale of subject-object affective connections. Int J Psychoanal 2000; 81 ( Pt 3):529-51. [PMID: 10967774 DOI: 10.1516/0020757001599942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The authors address the issue of inferring unconscious internal working models of interaction through language. After reviewing Main's seminal work of linguistic assessment through the 'adult attachment interview', they stress the idea of adults' internal working models (IWMs) as information-processing devices, which give moment-to-moment sensory orientation in the face of any past or present, animate or inanimate object. They propose that a selective perception of the objects could match expected with actual influence of objects on the subject's self, through very simple 'parallel-processed' categories of internal objects. They further hypothesise that the isomorphism between internal working models of interaction and grammatical connections between subjects and objects within a clause could be a key to tracking positive and negative images of self and other during discourse. An experiment is reported applying the authors' 'scale of subject/object affective connection' to the narratives of sixty-two subjects asked to write about the 'worst' and 'best' episodes of their lives. Participants had previously been classified using Hazan & Shaver's self-reported 'attachment types' (avoidant, anxious and secure) categorising individuals' general expectations in relation to others. The findings were that the subject/object distribution of positive and negative experience, through verbs defined for this purpose as either performative or state verbs, did significantly differ between groups. In addition, different groups tended, during the best episodes, significantly to invert the trend of positive/negative subject/object distribution shown during the worst episode. Results are discussed in terms of a psychoanalytic theory of improvement through co-operative elaboration of negative relational issues.
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Seganti A. Prototypical expectations of safety: a developmental approach to the assessment of the psychoanalytic process. Int J Psychoanal 1995; 76 ( Pt 6):1245-55. [PMID: 8789173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The author proposes that developmental research into the main experiential components of internal working models and process research into central patterns of interaction between analyst and patient may share similar theoretical assumptions. A developmental hypothesis bridging these two areas of research is proposed, in which repeated success or difficulty in mutual regulation during infancy result in an emotionally charged set of 'prototypical expectations' that continually influence the sense of personal safety. The author argues that prototypical expectations interfere in the psychoanalytic process because they allow the defensive warding off of negative expectations and so parallel explorations of new relational solutions. An analysand's narratives can be considered to express the conflict between negative transference (generally expressed in relation to extra-transference interactions) and defensive positive transference (more likely to be explicitly connected with the therapeutic situation). During the analytic process, ambivalent transference should appear in both 'worst' and 'best' types of narrative as an indication of warded-off negative transference working through. In this paper an application of the negative prototypical expectations processing hypothesis is presented through a formal discussion of the relational structure of the narratives of a 17-year-old boy's first four analytic sessions. The author demonstrates that this hypothesis makes it possible to predict the transference and the countertransference topics with which the patient and the analyst will have to cope during the treatment.
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Seganti A. [Communication problems in physician-patient relations]. Cardiologia 1985; 30:1077-81. [PMID: 3834987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Maggioni G, Vestri A, Seganti A. [Case of familial osteopetrosis associated with subvalvular aortic stenosis]. Minerva Pediatr 1972; 24:1149-54. [PMID: 4673168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Carile L, Rutiloni C, Seganti A. [Cardiac myxoma in children]. Minerva Pediatr 1968; 20:1089-94. [PMID: 5737963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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